<link rel="stylesheet" type="text/css" href="js/datePicker/My97DatePicker/skin/default/datepicker.css" media="screen">
<script type="text/javascript" src="js/datePicker/My97DatePicker/WdatePicker.js"></script>
<section class="content">
	<div class="row">
		<!-- left column -->
		<div class="col-md-12">
          <div class="box box-primary box-solid">
            <div class="box-header">
              <h3 class="box-title">参保转移</h3>
            </div>
            <div class="box-body">

				<form id="form" class="form-horizontal form-row-seperated" method="post" ng-submit="submit(data, data3);">
					<div class="form-body">
						<div class="form-group last">
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>姓名：</label>
								<div class="col-md-3">
									<input class="form-control" ng-model="data3.CA001" type="hidden" readonly>
									<input class="form-control" ng-model="data3.CA003" type="text" readonly> 
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>身份证号：</label>
								<div class="col-md-3">
									<input class="form-control" ng-model="data3.CA006" type="text" readonly> 
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>转入地行政区划：</label>
								<div class="col-md-3">
									<select class="form-control required" name="intoAddress"
										 ng-change="organClick(data.intoAddress)" ng-model="data.intoAddress"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data" value="{{d.AAB301}}">{{d.AAA146}}</option>
									</select> 
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>转入街道：</label>
								<div class="col-md-3">
									<select class="form-control required" name="intoStreet" 
										ng-change="organVillageClick(data.intoStreet)" ng-model="data.intoStreet"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data1" value="{{d.AAB301}}">{{d.AAA146}}</option>
									</select>  
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>转入地村（居）委会：</label>
								<div class="col-md-3">
									<select class="form-control required" name="intoVillage" ng-model="data.intoVillage"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data2" value="{{d.AAB301}}">{{d.AAA146}}</option>
									</select>  
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>转出日期：</label>
								<div class="col-md-3">
									<!--<input type="text" ng-model="data.date" class="form-control Wdate" style="height:34px;border: 1px solid #ccc;cursor:default" onFocus="WdatePicker({lang:'zh-cn'})" />   -->
									<input class="form-control required Wdate" id="date" ng-model="data3.date" type="text" style="height:34px;border: 1px solid #ccc;cursor:default" onFocus="WdatePicker({dateFmt:'yyyy-MM-dd'})" readOnly> 
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2">备注：</label>
								<div class="col-md-8">
									<input class="form-control" ng-model="data.remarks" type="text" placeholder="请输入备注"> 
								</div>
							</div>
							</br>
							<div class="row" style="margin-left:20px">
								<label for="exampleInputFile" class="control-label col-md-4">
									<span class="data_text_star">*</span>户口本图片（转入地户口本本人页照片）：</label>
								<div class="col-md-4">
									<input type="file" id="exampleInputFile" class="required" style="padding:10px 0px;"
										 name="exampleInputFile" accept=".jpg,.JPG,.png,.PNG">
								</div>
							</div>
						</div>
					</div>
					<div class="box-footer">
						<button type="submit" class="btn btn-primary">
							<i class="fa fa-check"></i>保存
						</button>
					</div>
				</form>
				

            </div>
			
            <!-- /.box-body -->
          </div>
          <!-- /.box -->
        </div>
	</div>
</section>